A draft Department of Health plan seen by HSJ reveals key details of the development and authorisation process for clinical commissioning groups.

It reveals that by as early as October emerging CCGs should be rated red, amber or green, based on the likelihood of whether their size and shape being approved.

The document, Developing clinical commissioning groups: towards authorisation, has been sent to primary care and other groups for feedback and the final authorisation framework will be confirmed in a later publication.

It says CCGs can be authorised and become statutory bodies from October 2012. They will be required to “demonstrate an adequate level of competence… and the potential to achieve excellence in future” in the following areas:

  • A strong clinical and professional focus which brings real added value;
  • Meaningful engagement with patients, carers and their communities;
  • Clear and credible plans which continue to deliver the quality, innovation, productivity and prevention challenge within financial resources, in line with national outcome standards and local joint health and wellbeing strategies;
  • Proper constitutional and governance arrangements, with the capacity and capability to deliver all their duties and responsibilities including financial control as well as effectively commission all the services for which they are responsible;
  • Collaborative arrangements for commissioning with other CCGs, local authorities and the NHS Commissioning Board as well as the appropriate external commissioning support
  • Great leaders who individually and collectively can make a real difference.

However, it does not include clear “bars” for how capable groups must be in these areas, or a list of particular conditions to be met.

A foreword by NHS chief executive Sir David Nicholson says: “This document sets out the early thinking on the authorisation process - the process by which you would be assessed as ready to take on responsibility for health care budgets for your local communities…

“Authorisation should not be seen as an end point, but as a journey which can begin adding value to the communities we serve right from the start.”

A “road map” for commissioning begins with a risk assessment of “the proposed ‘configuration’” of CCGs, expected to take place “as soon as possible from October 2011, and ideally no later than December 2011”.

There are new “principles” for the geography and shape of CCGs including that there must be a “defined geographical area, which must not be overly convoluted”, and “the GP practices that make up the CCG should not be drawn from a widely dispersed area”.

An annex to the document sets out that CCGs will be rated red if: “The CCG is very small and cannot identify a future arrangement through which it could secure the capacity and capability to carry out all its commissioning responsibilities within its running costs.” Sources said it is likely to rule out very small CCGs, covering populations of fewer than 50,000, however the minimum acceptable size remains unclear.

The conditions will rule out a number of existing emergign commissioning groups, including some made “pathfinder” pilots by the DH.

The second stage of the “road map” is the “development path… the period during which emerging CCGs can gain experience and continue to build up a track record, that will serve you both in the authorisation process and in the responsibilities you wish to take on”.

Commenting on the draft, a DH spokeswoman said: “Clinical commissioning groups are at the heart of our NHS modernisation plans. They will put healthcare professionals in the driving seat so that they are free to deliver better quality and integrated care, closer to the patient.

“This initial thinking, which has been developed by a range of stakeholders, represents our preliminary proposals for authorising clinical commissioning groups. This will support emerging clinical commissioning groups in their development and enable them to be as prepared as possible for authorisation as well as taking on responsibility for healthcare budgets and improving services for their local communities.”